Allergy and asthma proceedings最新文献

Background: Autoimmunity and autoinflammation are increasingly recognized manifestations of immune dysregulation in patients with primary immunodeficiency (PID), alongside recurrent infections. Objective: The objectives were to determine the prevalence of autoimmune and autoinflammatory findings in patients with PID and to compare their clinical, laboratory, and immunologic characteristics. Methods: This retrospective study included 130 adult patients with PID who were followed up at a tertiary university immunology clinic. The patients were divided into three groups: those without immune dysregulation (group 1), those with predominant autoimmune features (group 2), and those with predominant autoinflammatory features (group 3). Demographic data, laboratory parameters, immunoglobulin levels, lymphocyte subsets, switched memory B cells, and genetic mutation data were analyzed. Results: Autoimmune manifestations were predominant in 32.3% and autoinflammatory findings were predominant in 9.2% of the patients. The patients in group 3 showed significantly elevated C-reactive protein, erythrocyte sedimentation rate (ESR), and fibrinogen levels (p < 0.05). Of the patients in group 2, the platelet count, serum immunoglobulin E (IgE) level, and switched memory B cells were significantly lower compared with other groups (p = 0.001, p = 0.007, p = 0.005, respectively). There were no significant differences in genetic mutation frequency or mortality among groups. Conclusion: Autoimmunity and autoinflammation are frequent in PID and associated with distinct immunologic profiles. Elevated acute phase reactants may indicate autoinflammation, whereas low IgE levels and decreased switched memory B cells may serve as early markers of autoimmunity. Routine evaluation for immune dysregulation in patients with PID is recommended.

Background: Hypogammaglobulinemia during infancy (HI) is often transient, resolves with time, and typically does not associate with a specific immunologic deficiency. If hypogammaglobulinemia persists, then it may be secondary to an immunologic disorder and be associated with significant clinically diagnosed infections. When phenotyping HI, any implications of associated atopic dermatitis (AD) can be clinically helpful. Objective: The purpose of this study was to explore the clinical and immunologic differences between patients who have HI and AD versus those with AD alone or with HI alone. Methods: We conducted a retrospective record review of patients with AD, HI with AD (HIcAD), and HI only seen in a large academic practice. Patient characteristics, comorbidities, clinical, and laboratory parameters as well as immunoglobulin G (IgG) at the last follow-up were noted. If HI resolved, then the age of resolution was noted. Data were analyzed by using the χ² test, Fisher exact test, Wilcoxon rank sum test, Monte Carlo estimates, and Kaplan-Meier product-limit curves, as appropriate. Results: There was no significant difference in age of presentation, gender at birth, or number or type of clinically diagnosed infections among the groups, but there was a significant difference in the levels of IgG, IgA, IgM, and IgE. More children in the HIcAD group had high IgE levels, significantly higher leukocyte counts, eosinophil counts, T and B cell numbers, and severe AD, and resolved HI in the study period than in the HI-only group. Conclusion: Analysis of our findings suggests that infants with HIcAD are more likely to have severe AD, to resolve hypogammaglobulinemia, and to have immunologic dysregulation without increased clinically diagnosed infections.

Background: Epinephrine is the first-line treatment for anaphylaxis, a potentially life-threatening allergic reaction. Despite this, real-world epinephrine use remains suboptimal. Objective: In this survey study of patients and caregivers of patients with anaphylaxis, the objective was to characterize real-world use of over-the-counter (OTC) medications alone or before epinephrine and to evaluate factors inherent to epinephrine delivery devices in contributing to delayed epinephrine use. Methods: Participants included U.S. patients (n = 100) and caregivers of patients with immunoglobulin E (IgE) mediated allergy (n = 100) who used an epinephrine autoinjector (EAI) in the past 12 months. A double-blind online survey evaluated allergy history, management of severe allergic reactions, and reasons for delaying epinephrine use. Results: Most respondents reported using OTC medications alone (88%) or before using an EAI (89%) to manage allergic reactions. During their most recent reactions, 42% of the respondents delayed or hesitated to use an EAI, with an average of 8.8 minutes before administration. The most impactful factor that contributes to delayed EAI use was concern about the device needle. Respondents who reported using OTC medications to manage most allergic reactions estimated that they would use needle-free epinephrine over OTC medications approximately three-fourths of the time. Conclusion: Despite potential risks of delaying using epinephrine, OTC medications are commonly used alone or before epinephrine use. Given the concerns about device needles identified in this survey, needle-free epinephrine offers an alternative to EAIs.

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a chronic lung condition that results from an overexuberant immune response, primarily to Aspergillus fumigatus. Diagnostic criteria have varied over time but current consensus requires elevated total immunoglobulin E (IgE) levels, A. fumigatus-specific IgE, and at least two of three of IgG response to A. fumigatus, elevated eosinophil levels, and imaging changes consistent with ABPA. The differentiation of asthma with A. fumigatus sensitization and ABPA remains controversial. Objective: To examine the results from a referral laboratory that provided analysis of specific antibody response to A. fumigatus via three assays: IgG index, IgE index, and IgG precipitins. The first two are measured by using an enzyme-linked immunosorbent assay (ELISA). Methods: Testing done for 539 consecutive patients evaluated for possible ABPA was analyzed. Results: Only 58 samples were positive for both IgG and IgE indexes, thereby meeting stringent serologic criteria for a diagnosis of ABPA. Only one third of the patients with a positive IgG index result also had positive precipitins results. Overall, the percentage of positive test results increased with age. Finally, the distribution of both A. fumigatus-specific IgG and IgE levels were approximately normal, not bimodal, which provides evidence that ABPA may exist on a spectrum with asthma with fungal sensitization. Conclusion: In this cohort, evidence of both an IgG and an IgE response to A. fumigatus was only seen in ∼10% of the samples, which indicated that ABPA is only found in a minority of patients in whom it is considered. ELISA is more sensitive than precipitins for identification of an overexuberant IgG response.

Background: Eosinophilic esophagitis (EoE) prevalence has been increasing in recent years and is associated with other atopic conditions. The association between EoE and the different atopic conditions is not well characterized. Objective: The objective was to assess the probability of developing EoE given different atopic conditions. Methods: Our retrospective cohort study used a de-identified electronic database of patient information to identify pediatric patients diagnosed with asthma, allergic rhinitis, atopic dermatitis, or food allergy. We ran separate analyses for each atopic condition and compared the probability of developing EoE with a control group that consisted of patients who had any diagnosis but without the one atopic diagnosis being studied. Cases and controls were matched for demographic factors and other atopic conditions. We contrasted the 3-year probability for developing EoE between matched cohorts and calculated the hazard ratios (HR) to quantify this interaction. Results: All studied atopic conditions studied were associated with an increased probability of developing EoE. Food allergy had the highest risk of developing EoE (HR 9.46 [95% confidence interval {CI}, 7.33-12.21]), followed by asthma (HR 4.11 [95% CI, 3.53-4.78]) and atopic dermatitis (HR 2.98 [95% CI, 2.42-3.67]), and was lowest for allergic rhinitis (HR 2.57 [95% CI, 2.21-3.00]). Conclusion: All atopic conditions, especially food allergy and asthma, were associated with an increased risk of developing EoE, which further supports the overlap among the different atopic diatheses.

Eczematous dermatitis is a heterogeneous group of inflammatory skin disorders characterized by pruritus, erythema, and scaling. The most common subtype is atopic dermatitis (AD), which has a continuously rising prevalence, particularly within industrialized regions, e.g., the United States. Distinguishing AD from other dermatoses, particularly among adult patients with recalcitrant disease, can be challenging. Conditions such as allergic contact dermatitis may mimic or coexist with AD, which complicate both diagnosis and management. This diagnostic complexity has been unmasked with the introduction of targeted biologic therapies, including interleukin (IL) 4, IL-13, and IL-31 inhibitors, which have brought meaningful advances to the treatment landscape but also demands greater diagnostic precision. In this context, failure to identify overlapping or alternative conditions may delay optimal patient management or result in unnecessary therapeutic escalation to systemic agents, some of which have notable risk profiles. This review highlights the critical need for comprehensive diagnostic guidelines for the evaluation of adults with presumed AD, particularly those who exhibit an incomplete response to therapy. Diagnostic tools such as biopsies, cultures, laboratory studies, and expanded series patch testing have the potential to reveal underlying or comorbid conditions that fundamentally alter management strategies. With evidence that substantiates that a majority of patients with AD and with residual dermatitis on biologic therapy test positive for relevant contact allergen(s) on expanded series patch testing, the Clear, Patch, Avoid, and Treat strategy exemplifies a practical, stepwise framework for evaluating treatment-resistant eczematous dermatitis, which reinforces the clinical value of early diagnostic assessment and allergen avoidance. Establishing clear, evidence-based protocols is essential to support dermatologists and allergists in delivering individualized, high-quality care. In the absence of such guidelines, a methodical and comprehensive diagnostic approach remains the best tool to improve outcomes and reduce the burden of misdiagnosis in patients with complex or treatment-resistant dermatitis.

Background: Allergic march refers to the association of multiple allergic diseases but current understanding primarily focuses on immunoglobulin E (IgE) mediated food allergies (FA) (IgE-FA). The impact of non-IgE-FAs on allergic march remains unclear. Objective: To determine whether food protein-induced allergic proctocolitis (FPIAP), a non-IgE-FA, coexists with other allergic diseases during follow-up and to identify predictive factors. Methods: Eighty-four patients diagnosed with FPIAP who had been followed up for at least 3 years and 89 age- and gender-matched controls were compared for the presence of concomitant allergic conditions. Results: Patients with FPIAP who were followed up regularly for at least 3 years were evaluated for the presence of concurrent allergic diseases at a median (interquartile range [IQR]) age of 50 months (47-54 months), whereas, in the age- and gender-matched control group, the median (IQR) age at evaluation was 51 months (47.5-57.5 months). Asthma, allergic rhinitis (AR), and IgE-FA rates in the FPIAP group were 29.8% (n = 25), 29.8% (n = 25), and 15.5% (n = 13), respectively, compared with 14.6% (n = 13), 13.5% (n = 12), and 3.4% (n = 3), respectively, in the control group. Asthma, AR, and IgE-FA were significantly more frequent in the FPIAP group (p = 0.03, p = 0.02, p = 0.01, respectively). Atopic dermatitis in those under the age of 2 years was more prevalent in the FPIAP group (38.6%, [n = 32]) compared with the controls (10.6% [n = 9]) (p = 0.001). Although vomiting at onset was identified as a predictive factor for asthma, maternal rhinitis and delayed introduction of complementary feeding were associated with an increased risk of developing AR in the FPIAP group. Conclusion: This study demonstrated a higher rate of asthma, AR, and IgE-FA in patients with FPIAP compared with age- and gender-matched controls. These findings emphasize the importance of increasing awareness of the potential coexistence of FPIAP with other allergic diseases.

Background: Asthma remains a substantial global health challenge, whereas epidemiologic data beyond 2019, particularly in the post-coronavirus disease 2019 era, are limited. This study aimed to provide a comprehensive view of the temporal and spatial trend of asthma burden and its attributable risk factors from 1990 to 2021. Methods: By using data from the Global Burden of Disease 2021 study, we analyzed the global, regional, and national trends in asthma incidence, deaths, and disability-adjusted life years (DALY) from 1990 to 2021. The smoothing splines models were applied to assess the relationship between the asthma burden and the sociodemographic index (SDI). An age-period-cohort (APC) model was used to study the detailed trend, and risk factor contributions were quantified. Results: Globally, asthma showed a favorable downward trend of incidence, deaths, and DALYs from 1990 to 2021. A negative correlation was found between SDI and the asthma burden. The APC analysis showed a relative high incidence rate in childhood and a high death rate in the elderly. A favorable period and cohort effect was observed. High body mass index has surpassed smoking as the leading risk factor for asthma-related deaths and DALYs. Conclusion: Although the asthma burden declined from 1990 to 2021, the overall issue with national and regional discrepancies persists. The shift in the leading risk factor necessitates targeted public health policies and interventions to effectively mitigate its impact.

Chronic urticaria in children can be related to viral infections, physical stimuli, autoimmune representation, autoinflammatory, or idiopathic. The cause of chronic urticaria, however, is rarely identified. We present a case of a 7-month-old girl with persistent urticaria that started at age 5 months, with poor response to H1 and H2 blockade, with a focus on identifying probable causes of her chronic urticaria. This case highlights the importance of an urticaria history and considerations for a broader evaluation given the clinical characteristics and patient's age.